Medicare is the Federal health insurance program for people 65 years of age or older. You may also be eligible for Medicare before age 65 if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig’s disease). 

Parts of Medicare:

• Part A (hospital insurance) covers in-patient care received at a hospital, skilled nursing facility, or hospice and some home health care.
• Part B (medical insurance) covers medical care received from doctors and other healthcare providers, outpatient care, home health care, durable medical equipment and certain drugs that are administered in a physician’s office or outpatient facility.
• Part D is drug coverage, which is offered through Medicare approved private plans
• Medicare Advantage (also known as Part C) are Medicare approved private plans that provide coverage similar to Part A and Part B combined. Some Medicare Advantage plans also include drug coverage.

Learn more about the different parts of Medicare.

Your FEHB plan may offer benefits that work with the Medicare program and could waive certain costs like deductibles, coinsurance, and copayments, when Medicare is primary or pays benefits first.

Additional plan options that FEHB offers to annuitants who are enrolled in Medicare include:

• Medicare drug benefits accessed through your FEHB plan provide standard Part D drug coverage such as a $35/month cap on insulin products and a yearly cap on out-of-pocket Part D drug costs.
• Medicare Advantage plans accessed through your FEHB plan cover what Medicare Parts A and B cover and some extra benefits like certain dental, vision, and hearing benefits. Medicare Advantage plans accessed through FEHB provide drug coverage similar to Part D drug coverage.

At-a-glance

Plans offered through FEHB:

Plans offered by Medicare:

*Additional enrollment options are detailed below.

A closer look

There are different ways to enroll in Medicare when you have FEHB. You must let your FEHB plan know when you enroll in Medicare so that your benefits are properly paid.

Medicare drug benefits accessed through your FEHB plan: Your FEHB plan will automatically enroll you if it offers Medicare drug benefits and you’re eligible for Part D. There’s no additional cost for the drug benefit.  You are eligible for this benefit if you only have Medicare Part A or Part B or both Part A and Part B.

You have the option to opt-out by contacting your FEHB plan before coverage begins. You may also disenroll, ending coverage after it begins, at any time. Disenrollment elections are effective the first day of the following month.

• Use the plan comparison tool to find a FEHB plan that offers Medicare drug benefits .

Medicare Advantage plans accessed through your FEHB plan: You must have Part A and Part B to elect a Medicare Advantage plan accessed through FEHB. 

• Use the plan comparison tool to find a plan. Contact the plan directly or follow the instructions in the plan brochure to enroll.

Part A and Part B: Use Social Security Administration’s tool to find when you can first enroll and when your coverage will begin. Enroll in Part A when you first become eligible. For most FEHB enrollees, this coverage is available premium-free. Part B coverage has a monthly premium.

• If you get Social Security or Railroad Retirement Board (RRB) benefits, you’ll be automatically enrolled in Part A and Part B when you turn 65 years old. You’ll have the option to opt-out of Part B.
• If you don’t get Social Security or RRB benefits, sign up for Part A and Part B online at gov, by phone at 1-800-772-1213, or in-person at your local SSA office.

Part D: You must have Part A and/or Part B to elect a Part D plan.

• Use the Medicare Plan Finder to find a Part D drug plan and enroll. You can also enroll by contacting the plan directly by phone or online or request a paper form. Or call Medicare at 1-800-633-4227, TTY users can call 1-877-486-2048.

Medicare Advantage (Part C): You must have Part A and Part B to select a Medicare Advantage plan. Most Medicare Advantage plans offer drug coverage. In that case, you’ll get drug coverage as part of your enrollment.

• Find plans and enroll by using the Medicare Plan Finder. You can also enroll by contacting the plan directly by phone or online or request a paper form. Or call Medicare at 1-800-633-4227, TTY users can call 1-877-486-2048.

Your Medicare premiums may be higher if your income is above a certain level. In most cases, the government pays 75% of the Part B premium. For higher income beneficiaries, the government subsidy ranges from 65% to 15% of the total premium. In other words, you may pay a higher premium for Part B and Part D depending on your income.

You’ll receive notification from the Social Security Administration if you must pay a higher premium.

• Check the Medicare costs table to learn what you may expect to pay in premiums and other costs.

Enrolling in Medicare doesn’t reduce or increase your FEHB premiums. Your FEHB premium will not change when Medicare becomes primary. You will continue to pay the same premium unless you change to another plan or option.

Avoid a tax penalty and end your Health Savings Account (HSA) contributions. You must stop contributing towards an HSA account at least six months before you enroll in Medicare Part A or Part B. You are not eligible to make HSA contributions and have Medicare.

Get additional coverage options when you enroll in Medicare. If you enroll in Part A and Part B, you will have the opportunity to enroll in a Medicare Advantage (Part C) plan. If you have Part A or Part B or both, you have the option to enroll in a Part D drug plan.

• Many Medicare Advantage plans accessed through FEHB and offering drug coverage reimburse some or all of your Medicare Part B premium.
• Medicare drug benefits accessed through FEHB plans offer expanded access to drugs at a lower cost than the drug coverage included in your FEHB plan.
• Get help lowering costs for your Medicare drug benefits accessed through FEHB plan or Medicare Part D drug plan through the Medicare Part D Extra Help program.

You may only be covered by one Medicare Part D or Medicare Advantage plan at a time. If you enroll in a FEHB plan that offers Medicare drug benefits or a Medicare Advantage plan accessed through FEHB, you will lose your coverage under a separate Medicare Part D plan or a Medicare Advantage plan.

You can make changes to your FEHB enrollment when you become eligible for Medicare or are covered under Medicare. These options are explained below.

Change FEHB enrollment. Becoming eligible for Medicare is a qualifying life event (QLE). This gives you a one-time opportunity to change your FEHB enrollment anytime beginning 30 days before you become eligible for Medicare.

Change plans. Once Medicare becomes the primary payer, you may find that a different FEHB plan will meet your needs. Some plans waive deductibles, coinsurance, and copayments when Medicare is primary or pays benefits first.

Suspend or cancel FEHB. Medicare Advantage plans offered by Medicare provide many of the same benefits as FEHB. Consider if you need FEHB coverage in addition to your Medicare Advantage plan. You have the option to suspend or cancel FEHB coverage if you do not want or need it while enrolled in Medicare Advantage. Before suspending or canceling FEHB, be sure to review the Medicare Advantage plan’s benefits carefully to ascertain sufficient coverage.   

• If you suspend FEHB coverage, you’ll have the option to reenroll.
• Canceling FEHB coverage as an annuitant is permanent. In other words, you will not have the option to reenroll in FEHB if you cancel your FEHB coverage.
• Consult with your retirement system to learn more about suspending, cancelling, and reenrolling in FEHB.

If you elect a Medicare Advantage plan accessed through your FEHB plan, you will not need to suspend FEHB coverage.

Re-enroll in FEHB after suspending your FEHB coverage for a Medicare Advantage plan. As an annuitant, you have the option to re-enroll in FEHB after suspending your FEHB coverage to enroll in a Medicare Advantage plan. You can re-enroll during the annual Federal Benefits Open Season or if you have a QLE.

You can always change plans or options during the annual Federal Benefits Open Season or if you have a QLE.

• QLEs are changes you can make in connection to certain events and must generally be done within 60 days of the event.